Healthcare Provider Details

I. General information

NPI: 1114433356
Provider Name (Legal Business Name): ALYSSA JOHNSON MA, BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ALYSSA THOMPSON

II. Dates (important events)

Enumeration Date: 12/26/2017
Last Update Date: 07/09/2020
Certification Date: 07/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2209 NORTHERN DR
BURLINGTON IA
52601-2256
US

IV. Provider business mailing address

7058 N 850TH AVE
CAMBRIDGE IL
61238-9248
US

V. Phone/Fax

Practice location:
  • Phone: 319-243-1524
  • Fax:
Mailing address:
  • Phone: 309-525-0611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberCB60799981
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: